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Signal Information Prediction of Mortality Identifies Unique Patient Subsets after Severe Traumatic Brain Injury: A Decision-Tree Analysis Approach.
Nonlinear physiological signal features that reveal information content and causal flow have recently been shown to be predictors of mortality after severe traumatic brain injury (TBI). The extent to which these features interact together, and with traditional measures to describe patients in a clinically meaningful way remains unclear. In this study, we incorporated basic demographics (age and initial Glasgow Coma Scale [GCS]) with linear and non-linear signal information based features (approximate entropy [ApEn], and multivariate conditional Granger causality [GC]) to evaluate their relative contributions to mortality using cardio-cerebral monitoring data from 171 severe TBI patients admitted to a single neurocritical care center over a 10 year period. Beyond linear modelling, we employed a decision tree analysis approach to define a predictive hierarchy of features. We found ApEn (p = 0.009) and GC (p = 0.004) based features to be independent predictors of mortality at a time when mean intracranial pressure (ICP) was not. Our combined model with both signal information-based features performed the strongest (area under curve = 0.86 vs. 0.77 for linear features only). Although low "intracranial" complexity (ApEn-ICP) outranked both age and GCS as crucial drivers of mortality (fivefold increase in mortality where ApEn-ICP 60 years of age died, whereas those with higher ApEn-ICP and GCS ≥5 all survived. Yet, even with low initial intracranial complexity, as long as patients maintained robust GC and "extracranial" complexity (ApEn of mean arterial pressure), they all survived. Incorporating traditional linear and novel, non-linear signal information features, particularly in a framework such as decision trees, may provide better insight into "health" status. However, caution is required when interpreting these results in a clinical setting prior to external validation
Detection of Coupling in Short Physiological Series by a Joint Distribution Entropy Method
Objective: In this study, we developed a joint distribution entropy (JDistEn) method to robustly estimate the coupling in short physiological series. Methods: The JDistEn method is derived from a joint distance matrix which is constructed from a combination of the distance matrix corresponding to each individual data channel using a geometric mean calculation. A coupled Rössler system and a coupled dual-kinetics neural mass model were used to examine how well JDistEn performed, specifically, its sensitivity for detecting weak coupling, its consistency in gauging coupling strength, and its reliability in processing input of decreased data length. Performance of JDistEn in estimating physiological coupling was further examined with bivariate electroencephalography data from rats and RR interval and diastolic time interval series from human beings. Cross-sample entropy (XSampEn), cross-conditional entropy (XCE), and Shannon entropy of diagonal lines in the joint recurrence plots (JENT) were applied for purposes of comparison. Results: Simulation results suggest that JDistEn showed markedly higher sensitivity than XSampEn, XCE, and JENT for dynamics in weak coupling, although as the simulation models were more intensively coupled, JDistEn performance was comparable to the three others. In addition, this improved sensitivity was much more pronounced for short datasets. Experimental results further confirmed that JDistEn outperformed XSampEn, XCE, and JENT for detecting weak coupling, especially for short physiological data. Conclusion: This study suggested that our proposed JDistEn could be useful for continuous and even real-time coupling analysis for physiological signals in clinical practice